NPIMap

Organization Active NPI

New York City Health and Hospitals Corporation

Doing business as Roosevelt Community Health Center of Excellence

  • Clinic/Center
  • Jackson Heights, NY
National Provider Identifier
1225765621
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Doing business as
Roosevelt Community Health Center of Excellence
Practice address
3750 72ND St
Jackson Heights, NY 11372-6143
Phone
(212) 238-7815
Fax
(212) 238-7629
NPI assigned
Aug 4, 2022
Last updated
Apr 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Luchy Jackson
Title
Director of Managed Care
Phone
(212) 238-7815

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3750 72ND St
Jackson Heights, NY 11372-6143

Mailing address

3750 72ND St
Jackson Heights, NY 11372-6143
Phone (466) 615-7800

Other names 1

  • Roosevelt Community Health Center of Excellence Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322001521 NY Part B Supplier - Clinic/Group Practice 4183535305 Receives reassigned benefits from 1,798 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20230418000267 NY Part A Provider - Federally Qualified Health Center (FQHC) 4082800305 Practice locations: Jackson Heights, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225765621. Details of each certification follow.

Federally qualified health center certification: CCN 331811

Legal name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Doing business as
ROOSEVELT COMMUNITY HEALTH CENTER OF EXCELLENCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 23, 2023
Last certification
Jan 23, 2023
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1970 in NY
Enrollment address
3750 72ND St
Jackson Heights, NY 11372-6143

Other NPIs with the same Medicare PAC ID 20

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 20

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

Locations

227 Madison St
Ste 166
New York, NY 10002

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Barbara a Lowe Individual Corporate DirectorBoard Member Mar 20, 2016
Vincent Calamia Individual Corporate DirectorBoard Member Jan 13, 2012
Gary Jenkins Individual Corporate DirectorBoard Member Jan 1, 2022
John E Ulberg Individual Corporate DirectorCfo Dec 19, 2018
Marjory J Karlin Individual Corporate DirectorChief Revenue Officer Aug 1, 2024
Anne Williams-Isom Individual Corporate DirectorBoard Member Jan 1, 2022
Anita Kawatra Individual Corporate DirectorBoard Member Jan 1, 2019
New York City Health and Hospitals Corporation Organization, New York, NY Operational/Managerial Control Jul 1, 1970 100%
Patricia Marthone Individual Corporate DirectorBoard Member Dec 20, 2021
Feniosky Pena-Mora Individual Corporate DirectorBoard Member Jan 1, 2019
Richard a Minott Individual Corporate DirectorSenior Director Dec 1, 2018
W-2 Managing EmployeeSenior Director Dec 1, 2018
Mitchell H Katz Individual Corporate DirectorBoard Member Jan 8, 2018
Jose Pagan Individual Corporate DirectorBoard Member Jan 1, 2019
Sally Hernandez-Pinero Individual Corporate DirectorBoard Member Jan 1, 2019
Ashwin Vasan Individual Corporate DirectorBoard Member Mar 14, 2022
Freda Wang Individual Corporate DirectorBoard Member Jan 1, 2019

Owners & managing parties with NPI records 21

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 21

All facility ownership & control disclosures 24

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Queens Hospital CenterJamaica, NY, CCN 33S231 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Elmhurst Hospital CenterElmhurst, NY, CCN 330128 Hospital Operational/Managerial Control Jan 1, 2011
Kings County Hospital CenterBrooklyn, NY, CCN 330202 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Metropolitan Hospital CenterNew York, NY, CCN 330199 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Metropolitan Hospital CenterNew York, NY, CCN 33S199 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2011
Metropolitan Hospital CenterNew York, NY, CCN 33T199 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Woodhull Medical & Mental Health CenterBrooklyn, NY, CCN 330396 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Harlem Hospital CenterNew York, NY, CCN 33S240 Hospital Operational/Managerial Control (100%) Mar 10, 2017
Coler Rehabilitation and Nursing Care CenterRoosevelt Island, NY, CCN 335063 Skilled nursing facility Operational/Managerial Control (100%) Mar 31, 2014
St. Nicholas Houses Child Health ClinicNew York, NY, CCN 571032 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Crown HeightsBrooklyn, NY, CCN 571023 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Brownsville Child Health ClinicBrooklyn, NY, CCN 571036 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Roberto Clemente Family Guidance CenterNew York, NY, CCN 571021 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Judson Health CenterNew York, NY, CCN 571031 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
La Clinica de Las AmericasNew York, NY, CCN 571014 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2006
Williamsburg Community Health CenterBrooklyn, NY, CCN 571094 Federally qualified health center Operational/Managerial Control (100%) Feb 10, 2018
Health Center at GunhillBronx, NY, CCN 571108 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2017
Greenpoint Community Health CenterBrooklyn, NY, CCN 571109 Federally qualified health center Operational/Managerial Control (100%) Feb 10, 2018
Vanderbilt Avenue Health CenterStaten Island, NY, CCN 571172 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
South Queens Community CenterJamaica, NY, CCN 571161 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Parsons Community Health CenterJamaica, NY, CCN 571173 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Woodside Houses Child Health CenterWoodside, NY, CCN 571170 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Corona District Health CenterCorona, NY, CCN 571168 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Women's Medical Center at CoronaCorona, NY, CCN 571165 Federally qualified health center Operational/Managerial Control Jul 1, 2018

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 23

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 23

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 67

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1225765621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 72ND ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726143",
            "telephone_number": "466-615-7800",
            "fax_number": "466-615-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 72ND ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726143",
            "telephone_number": "212-238-7815",
            "fax_number": "212-238-7629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK CITY HEALTH AND HOSPITALS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-04",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LUCHY",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "212-238-7815"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roosevelt Community Health Center of Excellence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.